Domhnall MacAuley: Illness hidden behind steel doors?

Domhnall MacauleyEver thought about prisoners? Not those unfortunates banged up in a far away jail; misguided young drug couriers, misunderstood plane spotters, or those whose foolish misdemeanours have been magnified through the eyes a different culture. They don’t tend to be forgotten.  And elsewhere, we sympathise with downtrodden citizens protesting in foreign dictatorships, slammed into jail for speaking up. It is easy to blame far away governments or totalitarian regimes. High Dudgeon seems reserved for problems in other people’s back yards.

Dare we look closer to home. What is happening in our own prisons? HIV, drug abuse, psychiatric illness, suicide, TB, hidden chronic disease. A quick glance at the literature reveals a litany of illness beyond belief in the developed world. When we read of medical scandals, we wonder how it could happen under our noses. We listen to debates about hard to reach groups, forgotten minorities, and hidden morbidity. This is followed by investigations, reports, then regulation while we wring our hands about yet another failing. Of course we care about social inequality but how much to we care about those unequals hidden from view behind barred windows and steel doors. They are there for a reason, but that doesn’t excuse us of our responsibility as a caring society. Illness is not part of their punishment. Perhaps we should be heaping resources on prisoners health, providing extra support to the medical services, and giving them the same help, finance, and profile as we would to other more media friendly causes. I remember being struck by the research from Dublin prisons by Shane Allwright, Joe Barry and colleagues a decade ago. It slips to the back of my mind but every so often I am reminded by media reports of drug abuse, suicide or murder. More recently, Ruth Elwood Martin worked with me at a research workshop when she shared her experience with prisoners in Vancouver. Research is very difficult to do, it is hard to get published, and prisoners are often wary of those associated with authority. Another reason why we hear to little. But, do our prisons hide a shameful sump of society? Do we know or do we even care?  Is this the next medical scandal?

Domhnall MacAuley is primary care editor, BMJ